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Periareolar endoscopic minimally invasive cardiac surgery: postoperative scar assessment analysis
Karel M Van Praet1, Markus Kofler1, Serdar Akansel1
1Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
Objectives:
The standard approach for minimally invasive cardiac surgery (MICS) for repair of the atrioventricular valves is a right lateral minithoracotomy. In this study, we report our experience with a periareolar endoscopic approach, which aims at an optimal cosmetic outcome while preserving optimal clinical outcomes.
Methods:
All patients underwent periareolar endoscopic MICS using high-definition three-dimensional endoscopic visualization without additional rib-spreading. Patients presented with degenerative and/or functional mitral regurgitation. Patients undergoing concomitant tricuspid valve surgery, cryo-ablation, patent foramen ovale closure, left atrial appendage occlusion and/or left atrial myxoma extirpation were included. This descriptive article analysed the aesthetic and functional outcome of the periareolar scar using 5 most common and clinimetrically sound scar assessment scales. For statistical analysis of the scar assessment grading scales, box and whisker plots were calculated depicting median, interquartile range and high and low range data points.
Results:
Median scar assessment scale scores for n = 100 male patients (response rate 100/109; 91.7%) were 2 [1, 4], 7.5 [6, 9], 11 [8, 14], 3 [2, 3] and 10 [9, 11] for the Vancouver scar scale, Manchester scar scale, patient scar assessment scale, Stony brook scar evaluation scale and Dermatology Quality of Life Index scale, respectively. Ninety-seven patients received mitral valve repair, 7 mitral valve replacement, whereas 5 had left atrial myxoma extirpation. Concomitant tricuspid annuloplasty, cryo-ablation, left atrial appendage occlusion and patent foramen ovale closure surgery were performed in 12, 29, 5 and 8 patients, respectively. Median procedure, cardiopulmonary bypass and cross-clamp times were 169.5 [154.3, 189.3], 111.5 [97, 127], and 68.5 [58.8, 81] min, respectively.
Conclusions:
Periareolar endoscopic MICS is safe and cosmetically appealing. It is feasible and allows for complex mitral valve repair, mitral valve replacement and concomitant surgery. Data from 5 scar assessment scales suggest that this technique delivers patient-satisfying results regarding functional and cosmetic outcomes.
Insights
This study shows that periareolar endoscopic minimally invasive cardiac surgery (MICS) for valve repair is safe and cosmetically pleasing. The technique provides excellent functional and aesthetic results for patients undergoing complex cardiac procedures.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Thoracic Surgery
Background:
- The standard right lateral minithoracotomy for minimally invasive cardiac surgery (MICS) offers clinical benefits but can result in noticeable scarring.
- There is a growing demand for surgical techniques that optimize both clinical outcomes and cosmetic results in cardiac procedures.
Purpose of the Study:
- To evaluate the safety, efficacy, and cosmetic outcomes of a periareolar endoscopic approach for minimally invasive cardiac surgery (MICS).
- To compare the aesthetic results of the periareolar approach with established scar assessment scales.
Main Methods:
- A cohort of 100 male patients underwent periareolar endoscopic MICS for atrioventricular valve repair or replacement, including complex concomitant procedures.
- High-definition 3D endoscopic visualization was utilized without rib-spreading.
- Scar assessment was performed using five validated scales: Vancouver, Manchester, Patient Scar Assessment, Stony Brook Scar Evaluation, and Dermatology Quality of Life Index.
Main Results:
- The periareolar endoscopic MICS approach was successfully applied in 100 patients, with high rates of mitral valve repair (97%) and various concomitant surgeries.
- Scar assessment scores indicated favorable cosmetic outcomes across all five scales, with median scores suggesting minimal scarring.
- Median procedure, cardiopulmonary bypass, and cross-clamp times were recorded as 169.5, 111.5, and 68.5 minutes, respectively.
Conclusions:
- Periareolar endoscopic MICS is a safe and effective alternative for atrioventricular valve surgery, offering significant cosmetic advantages.
- The technique is feasible for complex repairs and combined procedures, yielding patient-satisfying functional and aesthetic results.
- This approach represents a promising option for patients seeking optimal cosmetic outcomes in cardiac surgery.
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